African
Journals OnLine
South African Family Practice
Volume 25 Number 3, 2002
Audit of failure rate of sulfadoxine/pyrimethamine
combined with chloroquine to treat falciparum
malaria at single fourteen-day follow-up.
Vaughan Williams
Summary
Objective.
To assess the failure rate of the present first line treatment regime for
uncomplicated falciparum malaria of sulfadoxine/pyrimethamine combined
with chloroquine.
Design.
A before-after study1
Setting.
Ndumo Clinic, Ingwavuma District, South Africa, October 2000
Study Group. 55 patients presenting to Ndumo clinic with uncomplicated
malaria and malaria trophozoites visible on thin film.
Main outcome measures:Trophozoite count on thick film at day 14.
Results.
15 out of 37 patients who returned for follow-up still had trophozoites
on thick film. Symptoms of most patients at day 0 and day 14 were mild,
parasite counts before and after treatment were low, and trophozoites
were atypical.
Conclusions.
There appears to be an unacceptably high day 14 failure rate with the
combination of sulfadoxine/pyrimethamine and chloroquine.The mildness
of symptoms, low parasite counts and atypical trophozoites suggest
immunity to falciparum malaria amongst the local population. With few
antimalarials to chose from, the difficult question as to future treatment
of uncomplicated malaria arises.
Keywords: Falciparum malaria, chloroquine, sulfadoxine, pyrimethamine
Audit of failure rate of CoartemTM to treat
falciparum malaria at single fourteen-day follow-up
Vaughan Williams
Summary
Objective.
To assess the failure rate of the new first line treatment regime for
uncomplicated falciparum malaria in KwaZulu-Natal of CoartemTM tablets
(20mg artemether and 120mg lumefantrine — Novartis South Africa (PTY)
Ltd).
Design.
A before-after study1.
Setting.
Ndumo Clinic, Ingwavuma District, KwaZulu-Natal, South Africa, February
2001.
Study Group.
67 patients presenting to Ndumo clinic with uncomplicated malaria. diagnosed
by symptoms and positive immunochromographic test for plasmodium falciparum.
Main outcome measures.
Trophozoite count on thick film at day 14.
Results.
All of the 58 follow-up slides obtained were negative. 8 patients failed to
return, and 1 slide washed off. Only 43 smears were positive at day 0 of
which 36 had follow-up smears.
Conclusions.
No resistance to CoartemTM was shown at day 14, and CoartemTM has
been shown to be more effective at clearing falciparum malaria parasites
than a previous regime of sulfadoxine/pyrimethamine with chloroquine.
Keywords: Falciparum malaria, artemether,Lumefantrine
Public sector district health system: Is seven to ten minutes enough for patient management?
Haque, M
Summary
This paper looks at the reasons for the excessive workload of grass-root
and primary health care physicians at the Mitchell’s Plain Community
Health Centre in the Cape Town Metropolitan (CTM) South (Mitchell’s
Plain) district in South Africa. The development of a municipality based
district health system has created an opportunity to practice family medicine
in Mitchell’s Plain, but lack of clinical time to practice family medicine
in the current setting raises questions about the quality and efficiency of
primary health care in the municipality based district based health system.
To prevent the situation from developing into a ‘Diseased District
System!’1, enough clinical time and dedicated resources are urgently
required.
Keywords: Primary care ,workload, district health systems, public sector
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